基于影像与临床特征的急性前循环大血管闭塞性卒中血管内治疗后无效再通预测模型构建OA

Objective To investigate the independent risk factors for futile recanalization after endovascular therapy(EVT)in patients with acute anterior circulation large vessel occlusion stroke by integrating imaging and clinical features,and to construct and validate a risk prediction model based on these factors. Methods A retrospective analysis was conducted on patients with acute anterior circulation large vessel occlusion stroke who underwent EVT and achieved successful recanalization in the Department of Neurology,Fuyang People's Hospital from June 2023 to October 2025.General data,clinical data and imaging data were collected.Patients were divided into effective recanalization and futile recanalization groups based on the 90-day mRS score.Univariate logistic regression analysis was used to screen potential risk factors,followed by multivariate logistic regression to identify independent risk factors.A nomogram prediction model was constructed based on these factors,and statistical inference,internal validation,and subsequent calibration were performed.The predictive performance of the model was evaluated using ROC. Results A total of 247 patients were enrolled in this study,including 161 males and 86 females,aged 29-87 years,with a mean age of(65.2±10.8)years.Among them,119 patients were in the futile recanalization group.Compared with the effective recanalization group,the futile recanalization group had older age,higher proportions of diabetes mellitus,and atrial fibrillation,higher admission NIHSS score,blood glucose,and systolic blood pressure,more retrieval attempts,larger core infarct volume and hypoperfusion volume,lower Alberta stroke program early CT score(ASPECTS),and longer onset-to-recanalization time(all P<0.05).Multivariate logistic regression analysis showed that admission NIHSS score,ASPECTS,core infarct volume,and hypoperfusion volume were independent influencing factors for futile recanalization.The nomogram prediction model based on these factors had an AUC of 0.887(95％CI 0.826-0.927),sensitivity of 0.874,specificity of 0.859,and accuracy of 0.866.The calibration curve and Hosmer-Lemeshow test indicated good overall stability and high goodness-of-fit(P=0.431).Internal and subsequent validation demonstrated good calibration,predictive consistency,and reliable generalizability.Decision curve analysis suggested favorable clinical decision-making value. Conclusions Admission NIHSS score,ASPECTS,core infarct volume,and hypoperfusion volume are independent risk factors for futile recanalization after EVT in acute anterior circulation large vessel occlusion stroke patients.The prediction model integrating clinical features and imaging parameters has high predictive efficacy for the risk of futile recanalization after EVT.